MedicaidPrior AuthMedium impact
Aduhelm® (aducanumab-avwa) (Revised)
Humana·SC · Neurology, Geriatrics, Internal Medicine·Medicaid
Effective date
Nov 26, 2025
We identified it
Jun 25, 2026
Summary
Humana revised its Aduhelm (aducanumab-avwa) prior authorization policy for South Carolina Medicaid, effective November 26, 2025. The revision introduces stricter renewal criteria for continuation of therapy, including new ARIA (Amyloid-Related Imaging Abnormalities) monitoring thresholds and a requirement that providers attest potential benefits exceed risks. Initial approval remains 6 months, with renewals also at 6-month intervals.
Action Required
By November 26, 2025: Billing and clinical teams must immediately update prior authorization workflows for Aduhelm claims submitted under South Carolina Medicaid. Specifically: (1) Update PA request templates to include new Renewal Criteria #8 ARIA findings thresholds (5+ new microhemorrhages, ≥2 focal superficial siderosis areas, FLAIR hypersensitivity ≥5cm); (2) Configure billing system to require provider attestation for Renewal Criteria #13 stating that benefits exceed risks; (3) Update authorization tracking to flag renewals at 6-month intervals requiring re-evaluation of ARIA status via MRI; (4) Train providers and billing staff that claims for continuation beyond initial 6 months MUST include most recent MRI results demonstrating either absence of significant ARIA findings OR radiographic stabilization; (5) Implement checklist for PA submission requiring in-person evaluation documentation per Renewal Criteria #4. Failure to meet new renewal criteria will result in claim denials for continued Aduhelm therapy. This applies only to South Carolina Medicaid members.